Pregnancy and nursing in inflammatory bowel disease

The peak age of onset for IBD coincides with the peak age for conception and pregnancy. Women with inactive IBD who become pregnant do not have increased complications compared with age-matched controls. Most medications for IBD are safe in pregnancy. The greatest danger to a normal conception and pregnancy is active disease, not the medicine used to treat it. This article outlines fertility in IBD, the effect of IBD on pregnancy, the effect of pregnancy on IBD, and the medical therapy available.     

Encrusted pyelitis. Lithiasic disease with infectious etiology

We report on two new cases of encrusted pielitis, a lithiasic disease of infectious ethiology--Corynebacterium of D group-. The clinic diagnostic is difficult and this disease develops in immunosuppressed patients, mainly in renal transplanted ones. One of our two cases is diagnosed in a patient with a transplanted kidney and the other one develops the disease within her native kidneys. We remark on the clinic features and therapeutic options.     

Determination of thiopurine methyltransferase genotype or phenotype optimizes initial dosing of azathioprine for the treatment of Crohn's disease

BACKGROUND: although azathioprine (AZA) is an effective immunomodulator in treating Crohn's disease, some patients develop leukopenia and risk severe infections. Thiopurine methyltransferase (TPMT) is an enzyme responsible for the metabolism of AZA, and its activity is inversely related to the risk of developing acute leukopenia. GOALS: the aim of this retrospective study is to determine whether initial AZA dosing based on TPMT genotype or phenotype alters the likelihood of developing acute leukopenia. STUDY: between January 2000 and February 2001, 71 patients with Crohn's disease considered for AZA therapy and with a recorded TPMT genotype or phenotype were identified using a comprehensive text-oriented database at the University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, PA. The baseline demographics, TPMT genotype or phenotype, initial dose of oral AZA, subsequent white blood counts, and complications that necessitated discontinuation of therapy were evaluated. RESULTS: of the 63 patients with normal TPMT activity, 45 were started on 2 to 2.5 mg/kg/d of AZA, seven received doses less than 2 mg/kg/d, and 11 did not start AZA. Of the eight patients with intermediate TPMT activity, seven were started on 1 to 1.5 mg/kg/d of AZA, and one did not receive treatment. None of the patients that received AZA developed acute leukopenia (< 3,000/mm ). CONCLUSIONS: patients with Crohn's disease and normal TPMT activity who were started on high-dose AZA (2-2.5mg /kg/d) and patients with intermediate enzyme activity who were started on reduced doses of AZA did not develop acute leukopenia.     

Tuberculous peritonitis. Report of 2 cases

They are revised the clinical and diagnostic manifestations of tuberculous peritonitis. For this, it is provided our experience in three cases: 2 women and 1 man with ages between 49 and 79 years old. The more frequent clinical manifestations were general syndrome and ascites in all the cases (100%) and fever in 2 (66%). The mantoux was positive in two cases. The peritoneal fluid presented lymphocytic exudate and determination of adenosine deaminase increased in all the cases. The diagnosis was performed through laparoscopy with peritoneal biopsy with presence of necrotic granulomas. Only in 1 case,is identified growth of Mycobacterium tuberculosis in peritoneal fluid. All the patients answered positively to the specific treatment.     

Candida Infection of Cerebrospinal Fluid Shunt Devices: Report of Two Cases and Review of the Literature

Use of CSF shunt devices is a common practice in neurosurgery, and infection of the shunt is the most frequent complication. In spite of the fact that bacteria are the most widely implicated pathogens, reports of fungal infections, especially due to Candida sp., have increased in recent years. Their reported frequency ranges between 6% and 17%. Many factors have been implicated in the pathogenesis of Candida meningitis, such as broad spectrum antibiotics used in the treatment of a bacterial meningitis, steroids and indwelling bladder and intravenous catheters. The treatment of Candida meningitis still consists of systemic antifungal agents and removal of the shunt.     

Alteration of clonal profile II. Studies on the capacity of BALB/c splenic B cells to perpetuate responsiveness to phosphorylcholine and T15 idiotypic dominance

(CBA/N × BALB/c)F₁ hybrid male mice are unable to mount anti-phosphorylcholine (PC) plaque-forming cell (PFC) responses because they carry the CBA/N X-linked immune defect of B lymphocyte differentiation. Transplantation of splenic B cells from BALB/c mice restores responsiveness to thymus-dependent and thymus-independent PC antigens up to 8 months after cell transfer. Cytotoxicity studies demonstrate the donor origin of PFC generated in reconstituted (CBA/N × BALB/c)F₁ mice. Although responsiveness to PC is restored permanently, a shift in idiotype expression that leads to the loss of T 15 idiotypic dominance 3 months after cell transfer can be detected. This shift originates from Ig^? cells because Ig⁺ splenic cells purified in a fluorescence-activated cell sorter maintain T15 dominance. Therefore, the Ig⁺ cells have a remarkable capacity to maintain responsiveness to antigens and can perpetuate idiotypic dominance if the stem cell pool is removed.     

Total HCV core antigen assay. A new marker of HCV viremia and its application during treatment of chronic hepatitis C

The present study assesses the clinical usefulness of the hepatitis C core antigen assay for monitoring of patients being treated for chronic hepatitis C virus (HCV) infection. Eighty-six serum samples were selected at random from 16 patients and levels of HCV RNA and HCV core antigen were determined simultaneously and in parallel to compare both techniques. The data obtained were compared by Pearson’s correlation and the coefficients calculated by Fisher transformation and by calculating the difference and standard error. A good linear correlation was observed between both techniques. Maximum correlation, with significant difference, was found between patients infected with the 1a genotype and other genotypes. In conclusion, the HCV core antigen assay is useful for the diagnosis of early infection; however, its use for determining the exact timing of viral elimination during treatment is clearly unsuitable.     

Herpesvirus saimiri immortalization of {alpha}{beta} and {gamma}{delta} human T-lineage cells derived from CD34+ intrathymic precursors in vitro

Herpesvirus saimiri (HVS), an agent that can infect many humancell types, has been shown to immortalize selectively TCR ß⁺CD3⁺T lymphocytes. Human T cell precursors defined as CD34⁺CD3^–CD4^–CD8^–were isolated from thymic samples and exposed to HVS in thepresence of either IL-2 or IL-7. Cultures lacking the viruswere non-viable by day 15. Test cultures, in contrast, showeda sustained proliferative activity lasting >5 months, allowingthe phenotypical and molecular analysis of the cellular progeny.In the presence of IL-7, TCR ß⁺ cells with three differentphenotypes (mainly CD4⁺CD8^–, but also CD4⁺CD8⁺ and CD4^–CD8⁺)were immortalized, whereas no TCR ⁺ cells were recovered. Kineticstudies showed that the expansion of immortalized TCR ß⁺cells was preceded by a gradual loss of CD34⁺ cells followedby a transient accumulation of two distinct cell subsets: firstCD1⁺CD4⁺CD3^– cells and then CD4⁺CD8⁺ thymocytes. Thisresembles early phenotypic changes occurring during normal intrathymicT cell development. In the presence of IL-2, in contrast, onlyTCR ⁺ cells were immortalized (mainly CD4^–CD8⁺, but alsoCD4^–CD8^–). The results show that HVS can be usedto read the CD3⁺ cellular outcome of T cell differentiationassays, including ⁺ CD4^–CD8⁺, ⁺CD4^–CD8^–, ß⁺CD4⁺CD8^–,ß⁺CD4^–CD8⁺ and ß⁺CD4⁺CD8⁺ T cells.A clear role for different cytokines (IL-2 for ⁺ cells, IL-7for ß⁺ cells) in early T cell commitment was alsoapparent.     

Human MHC Class III (Bf, C2, C4) genes and GLO: their association with other HLA antigens and extended haplotypes in the Spanish population

C4 allotype frequencies and their combination with factor B and C2 alleles (complotypes) were studied in a sample of the Spanish population in relation to MHC class I, class II and GLO alleles. The shorter genetic distances found for C4 between Spaniards and North Africans and the high frequency of extended HLA haplotypes (GLO 2) HLA-DR3 F1C30 HLA-B18 HLA-Cw5 (HLA-A30) and HLA-DR7 S1C21 HLA-Bw50 HLA-Cw6 are consistent with a paleo-North African ethnic origin (about 20,000 years B.C.) of a part of present Spaniards (Iberians), and with the effect of racial admixture during late Moslem invasions (from the 8th to the 15th century). The complotype null alleles C4A QO and C4B QO may be under natural selection pressure when found in cis position, since they are never in the same haplotype in families. The underestimation of these C4 null alleles' frequencies in unrelated individuals as compared to genotyped families is shown to be a very likely event and a serious hindrance for C4-disease association studies. We have not found any C4 duplications in the Spanish population; this may be due to sample size limitations or to the degree of admixture of our population. Strikingly, no positive linkage disequilibrium between C4A and C4B alleles is detected in unrelated individuals nor in families, although strong associations are maintained among Bf, C2, C4, HLA-A, HLA-B, HLA-C and HLA-DR markers. Assuming that all MHC polymorphisms have reached equilibrium, several explanations are proposed, including the possibility of no, different or additional natural selection mechanisms operating on some MHC class III genes (Bf, C2, C4 alleles combinations for most appropriate C3 convertases), as compared to those affecting class I and class II gene clusters (most advantageous immune response genes sets).